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. 2023 Apr;101(5):918-931.
doi: 10.1002/ccd.30616. Epub 2023 Mar 8.

Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

Alexandre Avran  1 , Andrea Zuffi  2 , Cecilia Gobbi  2 , Alessio Gasperetti  3 , Marco Schiavone  4   5 , Gerald S Werner  6 , Mashayekhi Kambis  7 , Nicolas Boudou  8 , Alfredo R Galassi  9 , George Sianos  10 , Moussa Idali  2 , Roberto Garbo  11 , Andrea Gagnor  12 , Gabriele Gasparini  13 , Alexander Bufe  14 , Leszek Bryniarski  15 , Artis Kalnins  16 , Daniel Weilenmann  17 , Jaroslaw Wojcik  18 , Pierfrancesco Agostoni  19 , Nenad Z Bozinovic  20 , Mauro Carlino  21 , Sergey Furkalo  22 , David Hildick-Smith  23 , Laurent Drogoul  24 , Julien Lemoine  25 , Antonio Serra  26 , Stefano Carugo  27 , Imre Ungi  28 , Joseph Dens  29 , Nicolaus Reifart  30 , Joseph Cosma  2 , Vincenzo Mallia  27 , Giuseppe Vadalà  31 , Giuseppe Biondi-Zoccai  32   33 , Carlo Di Mario  34
Affiliations

Gender differences in percutaneous coronary intervention for chronic total occlusions from the ERCTO study

Alexandre Avran et al. Catheter Cardiovasc Interv. 2023 Apr.

Abstract

Background: Gender-specific data addressing percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) in female patients are scarce and based on small sample size studies.

Aims: We aimed to analyze gender-differences regarding in-hospital clinical outcomes after CTO-PCI.

Methods: Data from 35,449 patients enrolled in the prospective European Registry of CTOs were analyzed. The primary outcome was the comparison of procedural success rate in the two cohorts (women vs. men), defined as a final residual stenosis less than 20%, with Thrombolysis In Myocardial Infarction grade flow = 3. In-hospital major adverse cardiac and cerebrovascular events (MACCEs) and procedural complications were deemed secondary outcomes.

Results: Women represented 15.2% of the entire study population. They were older and more likely to have hypertension, diabetes, and renal failure, with an overall lower J-CTO score. Women showed a higher procedural success rate (adjusted OR [aOR] = 1.115, confidence interval [CI]: 1.011-1.230, p = 0.030). Apart from previous myocardial infarction and surgical revascularization, no other significant gender differences were found among predictors of procedural success. Antegrade approach with true-to-true lumen techniques was more commonly used than retrograde approach in females. No gender differences were found regarding in-hospital MACCEs (0.9% vs. 0.9%, p = 0.766), although a higher rate of procedural complications was observed in women, such as coronary perforation (3.7% vs. 2.9%, p < 0.001) and vascular complications (1.0% vs. 0.6%, p < 0.001).

Conclusions: Women are understudied in contemporary CTO-PCI practice. Female sex is associated with higher procedural success after CTO-PCI, yet no sex differences were found in terms of in-hospital MACCEs. Female sex was associated with a higher rate of procedural complications.

Keywords: chronic total occlusion; female sex; gender differences; major adverse cardiac and cerebrovascular events; percutaneous coronary intervention.

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References

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